Multiple Systems Atrophy (MSA) involves the clinical triad of:
Inspiratory stridor is a common, important clinical manifestation in MSA.
Key features are orthostatic hypotension, urinary retention/incontinence, erectile dysfunction, anhidrosis, and other features.
Note that there is no MSA-A, since prominent autonomic dysfunction is always required.
Akinesia, rigidity, and postural instability most often without tremor; it resembles PD more-so than PSP.
We use MSA-P (formerly striatonigral degeneration, SDN), if parkinsonian symptoms predominate.
Ataxia and possible cerebellar speech.
We use MSA-C (formerly, olivopontocerbellar atrophy, OPCA), if cerebellar symptoms predominate.
"Hot cross buns sign" is a vommon radiographic finding in MSA.
Oligodendrocytes comprise glial cytoplasmic inclusions (GCI)
We show the pons in cross-section with a hot cross bun on top.
The white strips represent degenerated pontine white matter pathways within the pons (for more on these tracts, see our tutorial on the cortico-ponto-cerebello-thalamo-cortical pathway).
These are flame-shaped inclusions of alpha-synuclein.
Lewy bodies in PD also comprise alpha-synuclein but in PD the accumulation occurs in neurons; here, the accumulation is most notably in glial cells (namely, oligodendroctyes).